Predicting return of spontaneous circulation with ultrasound-guided carotid artery compression during chest compressions

In this study, we evaluated the diagnostic performance of intra-CPR Point-of-Care Ultrasound Carotid Artery Compression (POCUS-CAC) in predicting the return of spontaneous circulation (ROSC) during chest compressions.

A prospective, single-center study was conducted on patients presenting to the emergency department with cardiac arrest between June 2022 and November 2023. POCUS-CAC was performed every 30 seconds during continuous chest compressions to assess carotid artery compressibility. A prediction of ROSC was recorded if the carotid artery remained non-compressible during both the systolic and diastolic phases of chest compressions. ROSC was confirmed using manual pulse palpation and electrocardiogram rhythm analysis every 2 minutes. The diagnostic performance of intra-CPR POCUS-CAC, including accuracy, sensitivity, and specificity, was assessed. Receiver operating characteristic analysis was also performed. Multivariable analysis was used to determine factors associated with ROSC.

The study cohort included 37 patients, with a mean age of 71 years (standard deviation 18), and 57% were male. POCUS-CAC demonstrated 90.6% sensitivity, 87.2% accuracy, and an area under the curve (AUC) of 94.83% in predicting ROSC during rhythm checks conducted after two minutes of chest compressions. For final ROSC outcomes, POCUS-CAC had a sensitivity of 59.3% and specificity of 60.5%. Multivariable analysis identified POCUS-CAC as the strongest predictor of ROSC (odds ratio 39.25, 95% confidence intervals: 14.10–109.24, p<0.0001).

Intra-CPR POCUS-CAC demonstrated 87.2% accuracy and an AUC of 94.83% in predicting ROSC during chest compressions. This valuable, non-invasive tool may help facilitate faster ROSC determination, support real-time resuscitation adjustments, and enhance CPR quality monitoring.